Zdravniški Vestnik (Nov 2016)
Laparoscopic radical hysterectomy with lymphadenectomy: our experience
Abstract
BackgroundThe second most common cancer in women up to 65 years of age is cervical cancer. Same cancer is the leading cause of death from gynaecological deseases worldwide.The standard procedure for cervical cancer treatment with FIGO stage including IB2 is radical hysterectomy sec. Wertheim-Meigs-Novak with or without adnexa with radical pelvic lymphadenectomy and/or para-aortic lymphadenectomy. In the last two decades has with the development of laparoscopy also developed laparoscopic radical hysterectomy .Laparoscopic radical hysterectomy with pelvic and para-aortic lymph nodes dissection was performed for the first time by Nezhat with coworkers in 1989.Laparoscopic radical hysterectomy with pelvic and/or paraaortic lymphnode dissection in treatement of cervical cancer including FIGO stage IB1 is performed at Dep Ob/Gyn UKC Ljubljana since 2013. The purpose of this article is to evaluate the morbidity and safety of the procedure. MethodsWe retrospectively reviewed the medical records of patients with cervical cancer who underwent laparoscopic radical histerectomy with pelvic and/or paraaortic lymphadenectomy from April 2013 to May 2016. Results34 patient were included, 32 patients with CC FIGO stage IB1, 1 patient with CC FIGO stage IB2, 1 patient with CC FIGO stage IIB.There were four (11,8%) bladder lesions, all of them were corrected during the surgery, but no ureteral lesion! There was one (2,9%) surgical revision right after the surgery due to assumption of bleeding (though there was no active bleeding found).Three patients (8,8%) had permanent urinary dysfunction – retention. One patient (2,9%) had dehiscence of vaginal vault after 4 months (after sexual intercourse)There was no ureterovaginal/vesicovaginl fistula after surgery! The mean operating time was 2 hours 55 min, mean admission time after surgery was 8,7 days, mean blood loss during operation was 291 ml. ConclusionsLaparoscopic radical hysterectomy is the method of choice in cervical tumors including FIGO stage IB1.Percentage of bladder lesions is part of learning curve.Our goal in future is to decrease the percentage of bladder lesions and to decrease the percentage of patients suffering from bladder dysfunction by using „nerve sparing“ technic.We expect, the same results for 5 year survival rate as with patients treated with classical radical hysterectomy.
